When hospice reverts to the lowest common denominator and leaders obsess about metrics, it's time to speak. Self-inflated leaders assume clinicians give until their backs break, given no raises for years. A clinical ladder is a rainbow’s pot of gold. Others have a sorrier job and must be motivated by money. Abysmal leaders dangle extrinsic rewards for admission, hiring and EDBITA targets. “Sign on” bonuses entice people into a poor work environment. Employees’ voice equals their raise, zero.

Tuesday, August 27, 2013

Generic Hospice decided to blame individual employees who'd lost their hospice heart the last two years under a series of misguided and malodorous executive decrees. Our President had the gall to record on video his concern that Generic Hospice staff were missing their heartbeat and not claim responsibility for eviscerating our hospice's heart.

Get this, our former logo was a heart. When we changed companies for what felt like the third time, they rammed this generic "metric centered" cross on us. There wasn't a lick of heart in it and they knew it.

Just when our President couldn't go any lower, he did. This image master wrapped himself in the most pure part of hospice, a chaplain's cloth. It wasn't the first time I'd seen our beady-eyed leader don a godly cloak, simply by close association.

It was difficult to set poor management aside, but I tried to focus on this pure, good-hearted chaplain who worked for free for months, while our President enjoyed executive benefits, private dining, health club and concierge medical services. The Chaplain talked about organizational trauma inflicted on his hospice site, turnover, a series of poor executive directors, marketers there - then gone.

The President abdicated his responsibility for any declared organizational failures, especially human resource systems that could not select and retain good employees. He simply offered the chaplain's story as the tonic for demotivated hospice workers, blind to its obvious indictment of senior and corporate management.

The Chaplain wrote a song, which was in earnest a protest song. The timing was good given the 50th anniversary of Rev. Martin Luther King's famous "I Have a Dream" speech.

"I have a dream that one day in the corporate offices of Generic Hospice with its President, his lips dripping with executive rewards and employee manipulation, that one day in all of Generic's offices, people will appreciated for who they are, not just for how good they make superiors look or how much they drive to the bottom line. I have a dream that all people will be paid as much as Generic can afford, allowing workers to focus on doing good work, not some byzantine extrinsic reward system that treats people like marionettes.''With this change, we will be able to join hands and sing the old Negro spiritual. Free at last, free at last, thank God almighty, we are free at last."

Part of that freedom is recognizing when the innocent have been taken in by the devious for purposes of greed and manipulation. It doesn't demean the innocent at all, just leaders who would falsely wear their mantle.

Saturday, August 17, 2013

The darkness grows at our hospice site. Turnover is a constant. Staff come away traumatized from interactions with our site leader. There is only one criteria to this manager's decisions, whatever is needed to maintain their image in the present moment. That means what they told you yesterday could be completely reversed today. Remind them of yesterday's position and they'll flat out deny it, accusing you of distorting reality. It's a mind shattering experience, unless you realize what's happening. There is only one constant, making the executive feel superior, in control, looking good.

I calculate our manager cost the company $750,000 in two years. That's $25,000 each for thirty jobs. It's crazy expensive, a fact which doesn't seem to register with Gentiva Senior Management types, normally obsessed about money and numbers.

Anyway, a handful of us will try to lift the darkness from our site. Daily at a specified time, our crew will pray that our staff be protected from management toxicity, that God's spirit will lift our hospice team members, enabling them to provide a loving, caring presence to those on our service. God, please hear our prayer. Right now, no Gentiva representatives are listening.

Sunday, August 4, 2013

"Nice job in a difficult environment" was the refrain from investment house analysts to Gentive CEO Tony Strange and CFO Eric Slusser. Gentiva's story remains essentially on the same arc. Our highly leveraged company struggles in a declining volume and revenue environment. Hospice admissions were down 3% year over year and average daily census even lower at 4% vs. the prior year.

CEO Strange expected the company's home health marketing strategy could be replicated in hospice. After five quarters with no positive impact, Strange finally believes the company needs to do something different. I know a few people who could've saved him five quarters, had anyone asked.

Strange believes the U.S. is back to the mid to late '90's in terms of health care financial disruption and dislocation. Uncle Sam, as the main payor, intermittently scorches the health care earth. In such a scenario Congress and the White House signal their sponsors that they will soon be able to buy great healthcare assets at a deep discount. The Centers for Medicare and Medicaid, under the leadership of 25 year HCA executive Marilyn Tavenner, provides the financial pain to healthcare providers, including those specializing in post acute care.

Credit markets provide dirt cheap, easy credit, enabling the Genitva's of the world to de-lever by buying distressed health care providers. To a normal person it makes no sense, de-levering by taking on more debt. If one had too much debt from rent houses, how does it make sense to buy more? Think of it like toxic chemicals, where the solution is dilution. It's very difficult to dilute/de-lever over $900 million in debt. That's Gentiva's formidable task.

Strange didn't mention hedge fund investor Mario Gabelli's recent major buy of Gentiva stock. He did mention that Sales, General and Administrative expenses went down due to lower incentive compensation payouts. How might a major hedge fund investor with an eye on big gains combine with an executive team intent on a return to major incentive compensation payouts? It feels like Gentiva might start swinging for the fences.

Back to the call. Capital expenses for the first six months were $7 million, 1% of revenue. This is a paltry amount for a firm expected to transition to electronic health records. Gentiva conducted a hospice marketing campaign in four Southeast markets. Strange said admissions and ADC increased in these markets, although he did not say by how much. The company plans to expand the TV/Radio campaign to six more markets by the end of 2013. That's ten out of 165 locations, a mere 6%. The capex and marketing expenditures are hardly significant investments for a firm sitting on $185 million in cash and appear to be window dressing for analysts.

Tony said Gentiva plans to use its cash to buy down debt or grow through consolidation. That leaves employees, who he thanked at the end of the call, waiting for dressing crumbs to fall from the executive table. My fellow employees say it's been a rough three years under the Gentiva banner. How're things at Generic Hospice?